Bariatric surgery: An HIV-positive patient’s successful journey

Abstract

Bariatric surgery is becoming increasingly common in the UK. Little has been done to evaluate its place in HIV-positive patients. Here, we discuss a successful case and the complexities surrounding highly active antiretroviral therapy.

Antiretroviral considerations in HIV-infected patients undergoing bariatric surgery

“…The site of absorption for lopinavir is the small intestines, and limited data suggest that the jejunum is the predominant site . The reference serum peak level for lopinavir is 9600 ± 4400 ng/mL, and the reference trough is 5500 ± 4000 ng/mL, although a separate source suggests a reference trough as low as 700 ng/mL .…”

“…Of the 78 patients with HIV infection identified in the literature who underwent bariatric surgery, 15% of patients had some form of complication. These complications were unrelated to HIV, most commonly minor, and generally occurred during the early postoperative period with a limited number of patients experiencing a complication one‐year after surgery . Of these patients being treated for HIV in whom viral load data were reported, 96% (45/47) remained virally suppressed following bariatric surgery .…”

“…These complications were unrelated to HIV, most commonly minor, and generally occurred during the early postoperative period with a limited number of patients experiencing a complication one‐year after surgery . Of these patients being treated for HIV in whom viral load data were reported, 96% (45/47) remained virally suppressed following bariatric surgery . One individual who did not achieve viral suppression was maintained on dolutegravir monotherapy, which is not a recommended treatment strategy according to the DHHS guidelines for antiretroviral use in adults .…”

“…10,17,22,26,36,[49][50][51][52][53][54] Of these patients being treated for HIV in whom viral load data were reported, 96% (45/47) remained virally suppressed following bariatric surgery. 10,17,22,26,36,51,53 One individual who did not achieve viral suppression was maintained on dolutegravir monotherapy, which is not a recommended treatment strategy according to the DHHS guidelines for antiretroviral use in adults. 10,30 The other individual experienced significant postoperative nausea and thus antiretroviral therapy was being held.…”

Bariatric surgery in HIV-infected patients: review of literature

“…Eddy et al 55 reported a case of a 44-year-old HIV-infected female that underwent bariatric surgery in 2012. Diagnosed in 2007, she had been on HAART for four years with a suppressed viral load (less than 34 copies per ml) and CD4 count of 680 cells/mm 3 at the time of surgery.…”